CAJ | 학술논문

目的：观察术前静脉输注右美托咪定对鼻内镜视野能见度的影响。方法40例择期全麻下行功能性鼻内镜手术患者，ASAⅠ～Ⅱ级，随机分成右美托咪定组（D组， n=20）、对照组（C组，n=20）。D组在诱导前以1μg/kg静脉泵注右美托咪定10分钟，C组泵注等容量生理盐水。记录术前（T0）、泵注后10分钟（T1）、诱导插管后（T2），手术开始后每隔15分钟直至手术结束时的HR（T3～T11）；记录手术开始后每隔15分钟的Fromme评分，记为手术15分钟视野（F1）至手术120分钟视野(F8)；记录两组患者改良Lund-Kennedy分级(MLK分级)、手术时间、出血量、术前及术后1天血红蛋白（hemoglobin， Hb）、红细胞比容（red blood cell specific volume，Hct）值；于拔管后即刻对患者行拔管质量评价，拔管后30分钟评估Ramsay评分，观察并记录两组患者有无心动过缓、反射性高血压、低血压，ST段压低等不良反应。结果与C组相比，D组心率较慢，差异有统计学意义（P<0.0001）；除T0、T10、T11，其余时点两组间差异有统计学意义（P<0.05）；C组从T2开始，D组T1开始，HR变化差异有统计学意义（P<0.05），与C组相比，D组在F2～F6时手术视野评分较低，差异具有统计学意义（P<0.05）。与C组相比，D组出血量更少，差异有统计学意义（P<0.05）。两组术前Hb、Hct无明显统计学差异（P>0.05），与术前相比，两组Hb、Hct均明显降低（P<0.05）；与C组比较，D组Hb术前-术后、Hct术前-术后均较低，差异有统计学意义（P<0.05）。两组MLK分级与出血量成正相关，心率与术野分级成正相关，差异有统计学意义（P<0.05）。两组患者拔管时间差异无统计学意义（P>0.05）。与C在相比， D组拔管质量、Ramsay评分较高，差异有统计学意义（P<0.05）。术中4例病人出现心动过缓，未发现反射性心动过速、反射性高血压、ST段下移等不良反应。结论术前静脉泵注右美托咪定可有效改善鼻内镜的术野能见度，并改善术后拔管质量及镇静程度。目的：觀察術前靜脈輸註右美託咪定對鼻內鏡視野能見度的影響。方法40例擇期全痳下行功能性鼻內鏡手術患者，ASAⅠ～Ⅱ級，隨機分成右美託咪定組（D組， n=20）、對照組（C組，n=20）。D組在誘導前以1μg/kg靜脈泵註右美託咪定10分鐘，C組泵註等容量生理鹽水。記錄術前（T0）、泵註後10分鐘（T1）、誘導插管後（T2），手術開始後每隔15分鐘直至手術結束時的HR（T3～T11）；記錄手術開始後每隔15分鐘的Fromme評分，記為手術15分鐘視野（F1）至手術120分鐘視野(F8)；記錄兩組患者改良Lund-Kennedy分級(MLK分級)、手術時間、齣血量、術前及術後1天血紅蛋白（hemoglobin， Hb）、紅細胞比容（red blood cell specific volume，Hct）值；于拔管後即刻對患者行拔管質量評價，拔管後30分鐘評估Ramsay評分，觀察併記錄兩組患者有無心動過緩、反射性高血壓、低血壓，ST段壓低等不良反應。結果與C組相比，D組心率較慢，差異有統計學意義（P<0.0001）；除T0、T10、T11，其餘時點兩組間差異有統計學意義（P<0.05）；C組從T2開始，D組T1開始，HR變化差異有統計學意義（P<0.05），與C組相比，D組在F2～F6時手術視野評分較低，差異具有統計學意義（P<0.05）。與C組相比，D組齣血量更少，差異有統計學意義（P<0.05）。兩組術前Hb、Hct無明顯統計學差異（P>0.05），與術前相比，兩組Hb、Hct均明顯降低（P<0.05）；與C組比較，D組Hb術前-術後、Hct術前-術後均較低，差異有統計學意義（P<0.05）。兩組MLK分級與齣血量成正相關，心率與術野分級成正相關，差異有統計學意義（P<0.05）。兩組患者拔管時間差異無統計學意義（P>0.05）。與C在相比， D組拔管質量、Ramsay評分較高，差異有統計學意義（P<0.05）。術中4例病人齣現心動過緩，未髮現反射性心動過速、反射性高血壓、ST段下移等不良反應。結論術前靜脈泵註右美託咪定可有效改善鼻內鏡的術野能見度，併改善術後拔管質量及鎮靜程度。
목적：관찰술전정맥수주우미탁미정대비내경시야능견도적영향。방법40례택기전마하행공능성비내경수술환자，ASAⅠ～Ⅱ급，수궤분성우미탁미정조（D조， n=20）、대조조（C조，n=20）。D조재유도전이1μg/kg정맥빙주우미탁미정10분종，C조빙주등용량생리염수。기록술전（T0）、빙주후10분종（T1）、유도삽관후（T2），수술개시후매격15분종직지수술결속시적HR（T3～T11）；기록수술개시후매격15분종적Fromme평분，기위수술15분종시야（F1）지수술120분종시야(F8)；기록량조환자개량Lund-Kennedy분급(MLK분급)、수술시간、출혈량、술전급술후1천혈홍단백（hemoglobin， Hb）、홍세포비용（red blood cell specific volume，Hct）치；우발관후즉각대환자행발관질량평개，발관후30분종평고Ramsay평분，관찰병기록량조환자유무심동과완、반사성고혈압、저혈압，ST단압저등불량반응。결과여C조상비，D조심솔교만，차이유통계학의의（P<0.0001）；제T0、T10、T11，기여시점량조간차이유통계학의의（P<0.05）；C조종T2개시，D조T1개시，HR변화차이유통계학의의（P<0.05），여C조상비，D조재F2～F6시수술시야평분교저，차이구유통계학의의（P<0.05）。여C조상비，D조출혈량경소，차이유통계학의의（P<0.05）。량조술전Hb、Hct무명현통계학차이（P>0.05），여술전상비，량조Hb、Hct균명현강저（P<0.05）；여C조비교，D조Hb술전-술후、Hct술전-술후균교저，차이유통계학의의（P<0.05）。량조MLK분급여출혈량성정상관，심솔여술야분급성정상관，차이유통계학의의（P<0.05）。량조환자발관시간차이무통계학의의（P>0.05）。여C재상비， D조발관질량、Ramsay평분교고，차이유통계학의의（P<0.05）。술중4례병인출현심동과완，미발현반사성심동과속、반사성고혈압、ST단하이등불량반응。결론술전정맥빙주우미탁미정가유효개선비내경적술야능견도，병개선술후발관질량급진정정도。
Objective To evaluate the surgical field during functional endoscopic sinus surgery after pre-operative intravenous infusion of dexmedetomidine.Method Forty patients in ASA classⅠorⅡundergoing functional endoscopic sinus surgery were randomly assigned into either the group D or the group C. Patients in group D received an intravenous infusion of dexmedetomidine before induction, while patients in group C were infused with the same amounts of normal saline. HR were observed before operation (T0), 10 minutes after infusion (T1), right after intubation (T2), and every 15 minutes from the beginning to the end of the surgery (T3~T11). The Fromme scores were recorded every 15 minutes from 15 minutes after surgery to 120 minutes after surgery, noted as Fromme scores from operation 15 minutes to operation 120 minutes (F1~F8).The modified Lund-Kennedy score (MLK), the operation time,the blood loss, and the levels of hemoglobin and hematocrit were recorded before surgery and one day after surgery. The scores of extubation quality were recorded right after extubation, and the Ramsay scores were taken 30 minutes after extubation. Adverse effects such as bradycardia, reflex hypertension, hypotension and ST-segment depression were recorded. Result Compared with the group C, the heart rate is relatively lower in group D with statistical significance (P < 0.0001). The difference in time points except for the T0,T10 and T11 was statistically significant between the two groups (P < 0.05);There were statistically significant differences in heart rate variation from T2 in group C, while there were statistically significant differences in heart rate variation from T1 in group D. Compared with group C, the mean Fromme scores from F2 to F6 were relatively lower with statistically significant differences(P < 0.05). The amount of blood loss in group D was less than that in group C (P<0.05). Blood loss and MLK grading were positively correlated in both groups, furthermore, the heart rate and surgical field's visibility were also positively correlated, and the differences were statistically significant (P<0.05). Compared with the preoperative condition, Hb and Hct after surgery were decreased with significant difference (P<0.05). Compared with group C,preoperative-postoperative Hb and preoperative-postoperative Hct were relatively low with significant difference (P<0.05). No significant differences were found in the extubation time (P>0.05). Compared with group C, the extubation quality and Ramsay score in group D were significantly higher with statistical difference (P<0.05) .Conclusion Preoperative intravenous infusion of dexmedetomidine could improve the surgical field, extubation quality score and sedated state.